Dentist MP fights for HPV vaccination
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- Published: Wednesday, 22 January 2014 07:28
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Dentist MP, Sir Paul Beresford, has raised the need for gender-neutral HPV vaccination, which he said would lead to ‘a dramatic reduction’ in a number of cancers, including oral cancer. In reply minister, Jane Ellison, stressed the Government’s commitment to improving cancer outcomes and the importance of rapid diagnosis in improving survival rates for oral cancer.
The exchange took place in an adjournment debate on Jan 14. These debates provide an opportunity for back benchers to raise topics which a minister has to answer. Extracts of the exchanges follow.
Paul Beresford (Mole Valley, Conservative)
I must first declare a double interest as chairman of the all-party parliamentary group on dentistry and as a very part-time practising dentist. This means that I am a member of the profession that faces the detection and treatment of the appalling disease of oral cancer. Over the years I have detected perhaps seven cases among my patients. We picked them up at a very early stage, and I believe that as a result those involved were all successfully operated on and treated without disfigurement, and survived.
I recall being called in by a colleague for a second opinion on a patient who was very well known in the media. I confirmed my colleague’s opinion that the small growth behind the lower right wisdom tooth was cancer. My colleague referred him to a specialist oral surgeon. The patient then disappeared off our horizon. He did not return for regular check-ups or go to the oral surgeon. As I said, he was a famous media personality. About two years later, news reports stated that he had died in spite of late treatment involving massive oral surgery disfigurement. As we later discovered, he had not wanted to hear my advice or my colleague’s. He went to see his GP, who gave him a bottle of some green fluid to paint on the ulcer, thus allowing the cancer to grow. This sad example indicates the first problem of oral cancer—that there is insufficient awareness among the public, among general medical practitioners, and even, regrettably, within the dental profession.
The fourth factor, and the one on which I believe decisive action can be taken, is tackling the human papillomavirus. It is a very large family of viruses that infect the skin and lining of the cervix, vagina, anus, mouth and throat. There are two groups. One group—HPV 6 and 11—are relatively low risk, causing laryngeal and genital warts, while the other group carry a high risk of causing cancer. They are key in causing 13 different types of cancers, but of these viruses perhaps HPV 16 is the most dangerous.
The number of annual cases of HPV-causing cancers in men is rising significantly. They are not just oral cancers; they cover other areas as well. Indeed, if recent incident trends continue, the annual number of HPV-positive oropharyngeal cancers may surpass the annual number of cervical cancers by 2020.
Obviously, that trend will be affected by the success of HPV vaccines, which are advocated in this country for women but not for men. That is a little odd, because it appears that fewer men than women produce an immune response to HPV infection. HPV vaccines protect against HPV infection and disease, including cancers, in men as well as women.
Australia’s policy of vaccinating both males and females is producing herd immunity. The effect on HPV diseases, including cancers, has been quite dramatic. The last chart I happened to see showed a 90% decline in the number of patients—both men and women—diagnosed with genital warts, caused by HPV, at a Melbourne sexual health centre between 1 July 2004 and 30 June 2011.
HPV plays a role in oral cancer and it is clear that gender-neutral vaccination would lead to a dramatic reduction, over time, in a number of cancers, including oral cancer. Immunising boys and girls would achieve real herd immunity for all such cancers.
The burden of HPV-associated cancers is now almost the same on men as it is on women. Men currently face a significant and rising risk of HPV-associated diseases. I therefore put it to the Minister that it is not fair, ethical or socially responsible to have a public health policy that leaves 50% of the population vulnerable to infection. Such vaccination, combined with early detection and action on smoking and heavy drinking of alcohol, could save a huge number of lives just as we face a dramatic increase in oral cancer. I repeat that the next procurement round is in the offing: the moment and the opportunity is here now.
Jane Ellison (The Parliamentary Under-Secretary of State for Health; Battersea, Conservative)
I want to restate the Government’s commitment to making England among the best in Europe in improving all cancer outcomes, including for oral cancers. As part of that, we are committed to reducing the incidence or oral cancers, improving diagnosis rates when it occurs and of course improving outcomes for people diagnosed with the disease. My hon. Friend mentioned the fact that the earlier the oral cancer is caught, the more successful that can be.
My hon. Friend outlined the scale of the challenge and, as he said, the numbers are quite stark. In 2011, the latest year for which we have information, more than 6,000 people in England were diagnosed with an oral cancer, and in the same year, more than 1,600 people died of the disease. That is, as it were, a milestone in a significant and worrying increase in incidence since the 1970s.
I am grateful to my hon. Friend for raising the issue of HPV, which, as I have said, was recently a subject of interest in Westminster Hall. It is good that it is being debated so thoroughly, including in making the link to the different kinds of cancer with which HPV is associated. He will know that there is growing evidence that the human papillomavirus, which is already linked to the development of the more than 99% of cases of cervical cancer in women, is a major risk factor for about a quarter of head and neck cancer cases.
If we can reduce incidence of HPV in females through high uptake of the national vaccination programme, a reduction of other HPV-associated cancers in females and males is likely to follow, but I will pick up my hon. Friend’s good point about herd immunity. Since 2008, more than 6 million doses of vaccine have been given in the UK, with 87% of the routine cohort of girls completing a three-dose course in the 2011-12 academic year. That is one of the highest uptakes of any vaccination programme in the developed world.
These are complex issues, and the development of the evidence base, including mathematical models, by Public Health England, as well as the Committee’s deliberations, will take time. That process is important for ensuring that decisions are made using the best quality evidence, so we cannot hurry it. I explored with officials the possibility of taking those decisions more rapidly, but that relates to the quality of the evidence being assessed and the necessity of building the right models. That brings with it the concerns that my hon. Friend and other hon. Members have raised about fitting in with the timetable for vaccine procurement, and on that I can give a little reassurance. Should the JCVI recommend the targeted vaccination of men who have sex with men, flexibility in the contracted volumes within the current vaccine contract may allow such a programme to be undertaken without the need for a new round of vaccine procurement, if additional vaccine is available from the manufacturer in the required quantities.
I want to take this opportunity to talk not just about prevention, but to remember the importance of rapid diagnosis. My hon. Friend graphically illustrated the tragic consequences of late diagnosis or of an early diagnosis being ignored. With early-stage diagnosis, five-year survival rates are more than 80%, which is very good by the standard of these things. Clearly, doctors and dentists have a vital role to play. Since 2005, the “Referral Guidelines for Suspected Cancer”, published by NICE, have supported GPs in identifying symptoms of oral cancer and urgently referring patients. That guidance is currently being updated.
Furthermore, all dentists are now aware that patients presenting for dental care is an opportunity—quite rightly, as my hon. Friend said—to assess any symptoms that might suggest oral cancer and refer them if appropriate. A new patient pathway being piloted in 94 practices—he might be aware of this—includes an oral health assessment requiring dentists to examine the soft tissue of the mouth; assess a patient’s risk factor in relation to oral cancer; and offer advice on lifestyle changes. Given what we have said about the relevance of lifestyle to the potential for developing oral cancer, that is very important. Those pilots are under way, and a great deal is being learned from them.
Once a cancer has been diagnosed, both dentists and GPs can use an urgent referral pathway to ensure patients get rapid treatment. The latest data showed that 95.5% of patients urgently referred with suspected head and neck cancer, including oral cancer, were seen by a specialist within two weeks, which is excellent progress. To ensure that patients get appropriate treatment, NHS England published a service specification for head and neck cancer last summer. This was based on NICE guidance and set out what NHS England expects to be in place for providers to offer evidence-based, safe and effective services.
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